Chronic pulmonary embolism

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Chronic PE

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Chronic pulmonary emboli are mainly a consequence of incomplete resolution of pulmonary thromboembolism.

Radiographic features

CTPA

vascular CT signs include
- direct pulmonary artery signs
  - complete obstruction
  - partial obstruction
  - eccentric thrombus
  - calcified thrombus - calcific pulmonary emboli
  - pulmonary arterial bands/pulmonary arterial webs ^1,4-5,5
  - post-stenotic dilatation
- signs related to pulmonary hypertension
  - enlargement of main pulmonary arteries
  - the peripheral pulmonary arteries in affected segments may be narrowed ^{ref required}
  - pulmonary arterial calcification
  - tortuous pulmonary vessels
  - right ventricular enlargement/hypertrophy
- signs of systemic collateral supply
  - enlargement of bronchial and non-bronchial systemic arteries
parenchymal signs (often non-specific on their own):
- scars
- mosaic perfusion pattern
- focal ground-glass opacities
- bronchial anomalies

Nuclear medicine: V/Q scan

Some publications suggest that V/Q scanning may be more sensitive than CTPA in detecting chronic pulmonary embolic burden ⁶.

Complications

Increased vascular resistance due to obstruction of the vascular bed leads to pulmonary hypertension.

Differential diagnosis

Differential considerations on a CTPA include ⁵:

perivascular pulmonary oedema
artefacts/interpretational errors
- motion: breathing artefact
- flow ~~related~~-related artefact
- streak artefact
- misinterpretation
  - due to incorrect window settings
  - misinterpretation of veins as arteries
pulmonary arterial catheter ⁵
intrinsic intraluminal tumour
- pulmonary arterial sarcoma

~~-<li>calcified thrombus - <a href="/articles/calcific-pulmonary-emboli">calcific pulmonary emboli</a>~~
+<li>calcified thrombus - <a href="/articles/calcified-pulmonary-embolus">calcific pulmonary emboli</a>
~~-<a href="/articles/pulmonary-arterial-bands">pulmonary arterial bands</a>/<a href="/articles/pulmonary-arterial-webs">pulmonary arterial webs</a> <sup>1,4-5</sup>~~
+<a href="/articles/pulmonary-arterial-bands">pulmonary arterial bands</a>/<a href="/articles/pulmonary-arterial-webs">pulmonary arterial webs</a> <sup>1,4,5</sup>
~~-<li>focal <a href="/articles/ground-glass-opacification-1">ground-glass opacities</a>~~
+<li>focal <a href="/articles/ground-glass-opacification-3">ground-glass opacities</a>
-</ul><h5>Nuclear medicine: V/Q scan</h5><p>Some publications suggest that V/Q scanning may be more sensitive than CTPA in detecting chronic pulmonary embolic burden <sup>6</sup>.</p><h4>Complications</h4><p>Increased vascular resistance due to obstruction of the vascular bed leads to <a href="/articles/pulmonary-hypertension-1">pulmonary hypertension</a>.</p><h4>Differential diagnosis</h4><p>Differential considerations on a CTPA include <sup>5</sup>:</p><ul>
+</ul><h5>Nuclear medicine: V/Q scan</h5><p>Some publications suggest that <a title="V/Q scan" href="/articles/vq-scan-2">V/Q scanning</a> may be more sensitive than CTPA in detecting chronic pulmonary embolic burden <sup>6</sup>.</p><h4>Complications</h4><p>Increased vascular resistance due to obstruction of the vascular bed leads to <a href="/articles/pulmonary-hypertension-1">pulmonary hypertension</a>.</p><h4>Differential diagnosis</h4><p>Differential considerations on a CTPA include <sup>5</sup>:</p><ul>
~~-<li>artefacts/interpretational errors<ul>~~
+<li>
+<a title="CT artefacts" href="/articles/ct-artifacts">artefacts</a>/interpretational errors<ul>
~~-<li>flow related artefact</li>~~
+<li>flow-related artefact</li>
~~-<li>pulmonary arterial catheter <sup>5</sup>~~
+<li>
+<a title="Pulmonary artery catheter" href="/articles/pulmonary-artery-catheter">pulmonary arterial catheter</a> <sup>5</sup>

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